Warning Signs in Pregnancy

By Chris Woolston, M.S.

Now that you're pregnant, naturally you're paying closer attention to your body and taking better care of yourself. You're probably also marveling at your body's transformation. It's also wise to be aware of any signs of trouble. When the unexpected occurs, you may need prompt treatment to protect your baby.

What are the warning signs?

Here's a look at some potential warnings signs during pregnancy and what they might mean:

Vaginal bleeding. Don't be alarmed if you have a little bit of spotting early in your pregnancy. This is common and could be insignificant, but ALWAYS tell your doctor about it. Your doctor or midwife needs to evaluate you in case there is something wrong. If your bleeding is accompanied by cramps or if you're bleeding as heavily as you do when you have your period, contact your doctor immediately. You may be having a miscarriage.

In early pregnancy, it's not uncommon for women to experience a small amount of bleeding (often with a brownish tint), cramping or low abdominal pain, nausea, breast tenderness, or back pain. However, in some cases, these may also be signs of an ectopic pregnancy. An ectopic pregnancy is a pregnancy that occurs in one of the fallopian tubes instead of in the uterus. Ectopic pregnancies are considered a medical emergency, so if you have irregular vaginal bleeding, pain in the lower abdomen (often on one side) followed by severe pelvic pain, and/or shoulder pain, it's important to call your doctor right away.

You may spot a little in the second trimester, too, especially after sex. Tell your doctor about any spotting in case it's due to a medical condition that needs immediate treatment. Bleeding late in the second trimester or in the third trimester is especially concerning; It may be a sign of placenta previa, a potentially dangerous condition in which the placenta covers the cervix. If the bleeding is accompanied by cramping or stomach pain, the placenta may have separated from the uterine wall, a serious condition called placental abruption. Depending on the diagnosis, you may urgently need hospitalization.

Cramping. Your uterus has to expand early in your pregnancy, so a little cramping is completely normal. You shouldn't worry about cramps in the first month or so unless they cause severe pain or are accompanied by bleeding. Severe cramping and bleeding in the first trimester may signal an ectopic pregnancy or a miscarriage.

After the 20th week, menstrual-like cramps or stomach cramps, with or without diarrhea, may mean you're going into premature labor, which is a medical emergency. Other signs of premature labor include contractions that are less than 15 minutes apart, a dull backache, a feeling of pressure in the pelvis, and a change in vaginal discharge. If you think you're going into labor, get medical help immediately.

High blood pressure. High blood pressure is another important sign. If your blood pressure is over 140/90, or if you have a sudden, dramatic increase in blood pressure -- that is, either an increase of 30 millimeters in the top number of your blood pressure (systolic), or 15 millimeters in the bottom number of your blood pressure reading (diastolic) -- you may have preeclampsia.

Other signs or symptoms of preeclampsia may include elevated protein levels in your urine, visual changes and abdominal pain. A weight gain of more than 5 pounds in one week may be an important first clue that you might be developing preeclampsia. (According to the Merck Manual, an increase of either 30 mm Hg systolic or 15 mm Hg diastolic may indicate preeclampsia, even if the patients blood pressure is below 140/90.)

You don't have to have all of these symptoms, though, to be diagnosed with preeclampsia. It's important to call your doctor immediately if you have one or more of these signs.

Lack of kicking. After the 25th week of pregnancy, you should feel your baby kick at least four times over a one-hour period. If your baby ever seems unusually still, you may want to eat something and lie quietly on your side, paying close attention to your baby's movements. If you notice fewer than 10 movements in two hours, contact your doctor right away: The baby may be in distress.

Other signs of trouble:

Vaginal discharge, itching, genital sores, or warts. These could be signs of a treatable vaginal infection.

Severe headache or blurry vision. This could be a sign of high blood pressure or preeclampsia.

Fever over 101 degrees Fahrenheit. A high temperature, especially with chills or fever, can be a sign of an infection.

Severe nausea or vomiting. These symptoms can also be a sign of preeclampsia. Vomiting can also lead to dehydration.

Burning sensation or pain when urinating. These are possible signs of a bladder infection, which can lead to premature labor. Urinating smaller amounts than usual is also a warning sign that something may be wrong.

Constant, severe headache.

Any blow or injury to your lower abdomen, with or without pain.

As you keep these warning signs in mind, remember that you have a special insight into your pregnancy. If you ever feel that something isn't right, don't hesitate to contact your doctor.

References

March of Dimes. Miscarriage. October 2008
http://www.marchofdimes.com/professionals/14332_1192.asp

March of Dimes. Ectopic and Molar Pregnancy. August 2008.
http://www.marchofdimes.com/professionals/14332_1189.asp